1 reviews | Active since May 2010
Takes forever to pay claims, no sense of urgency
It is with great disappointment that I'm sending you this email. My parents have been with topmed for many years. My mom was admitted to hospital about 3 weeks ago. Firstly we couldn't get an authorization code cause the medical aid needed a treatment plan - the doctor couldn't give a treatment plan as they weren't sure as yet what was wrong with my mom. This has caused hours of me having to make endless phonecalls trying to resolve the matter. 3 weeks later - still no authorization code and outstanding bill of over R40 000. Apparently I was told that my mom staying in hospital 1st needs to be 'justified/motivated' by the doctor i.e Why was she admitted?what treatment medication did she receive?. I'm still sitting with my mouth open - do you guys think people go to hospital cause they want to be there? We pay every month and if something goes wrong - you pay the claim - end of story. Why must the patient run up and down and stress because topmed 1st needs to decide if my mom was sick enough to be there. I have NEVER ever experienced this kind of treatment from my medical aid! In HOSPITAL means exactly that - medical aid pays for everything that happens to you IN HOSPITAL!!!
Dear SDavis
TopMed Medical Scheme is a managed care based Scheme, in order for us to fulfil this, we have to ensure that when a patient is admitted to hospital, the diagnosis and treatment correlates.
In your mothers’ case, the diagnosis and treatment did not correlate, therefore the authorisation was declined and a appropriate treatment plan was requested. TopMed Medical Scheme has their members’ best interest at hart, and with each admission we ensure that our members’ get the best possible treatment.
Kind regards,
Chanele Schoonraad
Dear SDavis
TopMed Medical Scheme is a managed care based Scheme, in order for us to fulfil this, we have to ensure that when a patient is admitted to hospital, the diagnosis and treatment correlates.
In your mothers’ case, the diagnosis and treatment did not correlate, therefore the authorisation was declined and a appropriate treatment plan was requested. TopMed Medical Scheme has their members’ best interest at hart, and with each admission we ensure that our members’ get the best possible treatment.
Kind regards,
Chanele Schoonraad